双侧足趾皮瓣组合移植一期修复手部脱套伤并再造手指  

Combined implantation of bilateral flaps of toe on reconstruction of thumb and other fingers in the skin degloving injury of the hand at one stage

作　　者：张全荣[1] 寿奎水[1] 施海峰[1] 陆征峰[1] 魏苏明[1] 

机构地区：[1]江苏省无锡市手外科医院,214061

出　　处：《中华显微外科杂志》2006年第6期419-421,I0002,共4页Chinese Journal of Microsurgery

摘　　要：目的探讨足趾皮瓣瓦合组合移植一期修复全手套脱伤并拇手指再造的临床疗效。方法采用(足母)甲皮瓣加第二趾胫侧皮瓣瓦合再造拇指,带足背皮瓣覆盖手背,(足母)趾腓侧皮瓣与第二趾甲皮瓣瓦合再造手指带足背皮瓣覆盖手背和股前外侧皮瓣覆盖手掌创面3例；采用双侧(足母)趾腓侧皮瓣加第二趾甲皮瓣瓦合双手指,带双足背皮瓣覆盖手背及股前外侧皮瓣覆盖手掌创面2例。结果术后4例成活顺利,1例组合皮瓣成活,因示指指骨感染而将其切除后伤口愈合。随访半年以上3例,因手掌皮瓣臃肿行整形术,再造拇、手指外形良好,虎口开大4～5cm,恢复了痛、温、触觉,再造拇、手指瓦合皮瓣两点分辨觉在5～10mm,手掌10～15mm,修复拇手指均有2kg以上提力,并有较为满意的外观。另2例时间短,其中1例指外形良好,手掌皮瓣臃肿,轻微抓握作用,虎口开大3cm。另1例示指感染后畸形,虎口开大2．5cm,有轻微夹持作用。结论双足趾皮瓣瓦合移植在全手脱套伤中的拇手指再造改善指外形、保留足趾数是理想的方法。Objective To report the outcome of reconstruction of the thumb and other fingers in the skin degloving injury of hand at one stage with the toe＇s flaps. Methods （ 1 ） With wrap-around flap of the big toe combined tibular side flap of the second toe to reconstruct the thumb, with the dorsalis pedis flap to repair the skin defection of dorsal side of hand, with fibular side flap of the big toe combined the second toe＇s nail flap with dorsalis flap were covered the finger and dorsal side of hand and the femoral anterolateral flap was covered the palm side of hand in 3 cases. （2） With bilateral fibular side flap of the big toes combined the second toe＇s nail flaps to construct two fingers with bilateral dorsalis pedis flaps to repair the dorsal side of hand, and with femoral anteroledered flap to repair the palm side of hand in 2 case. Results Four cases survived, 1 case＇s flaps survived but the bone of the index finger was infected, the injury healed after taking the bone out. 3 cases followed-up more than 6 months which were taken care of plastic procedure for its＇ fat appearance, the appearance of the thumbs and fingers were good, the width of the first web were 4-5cm, the sense of pain, warm,touch were rgained, the 2-PD were 5-10mm, the 2-PD of the palm side of hand were 10-15mm, the strength of thumb and finger were more than 2 kg, and the appearance of hands were satisfactory. The finger＇s appearance of one of the other 2 cases was good but the flap of the first web was 3cm. The other case＇s index finger was polydacty for infection, the width of the first web was 2. 5cm with poor picking function. Conclusion The toe＇s flap of double side to repair the skin degloving injury is a good approach in improving the appearance of the thumb and finger and retain the count of toes.

关 键 词：指 趾 外科皮瓣 移植 显微外科 

分 类 号：R658.2[医药卫生—外科学]